Name: ____________________

School: _________________

MENTOR TIME SHEET 2015-2016: FOURTH QUARTER

Please be sure to record at least 40 minutes of mentoring activities each week. For each activity you
engage in with your mentee, document the activity using this form. Please explain thoroughly the
activities completed with the mentee in the space provided.

Activity
Instructional Planning / Design
___ Daily lesson planning
___ Long-range planning / pacing
___ Aligning instruction and assessment with
the essential curriculum
___ Lesson openers / closure
___ Cooperative learning strategies
___ Using hands-on activities
___ Technology-based lessons
___ Other: ____________________________

Meeting Individual Student Needs

___ Planning/implementing differentiated
instruction
___ Addressing the needs of students with
various learning styles
___ Use of assessment data to improve
and individualize instruction
___ Other: ____________________________

Classroom Management
___ Disciplining with dignity
___ Addressing specific student behaviors
___ Effective time management
___ Increasing class participation
___ Promoting equitable class participation
___ Other: ____________________________

Parent Communication
___ Communicating with parents
___ Preparing for parent / teacher
conferences
___ Other: ____________________________

Date(s)

Time
spent

Comments / Explanation

Assessment
___ Questioning techniques
___ Alternative & authentic assessments
___ Self-evaluation/reflection by students
___ Discussing assessment / grading
practices
___ Preparing for local & state
assessments
___ Other: ____________________________

Administrative Duties /
Organization
___ Understanding administrative policies
___ Completing administrative paperwork
___ Preparing for administrative
observations
___ Organizing files & materials
___ Preparing for end of semester / year
___ Other: ____________________________

Classroom Visitations
___ Pre-visit conference
___ Classroom visitation of mentee by mentor
___ Classroom visitation of mentor by mentee
___ Post-visit conference
___ Other: ____________________________

Promoting Personal Growth

___ Self-evaluation and reflection by mentee
___ Collaborative teaching opportunities
___ Professional development (resources)
___ Other: ____________________________

TOTAL TIME (MIN. 40 MINUTES PER WEEK)

Mentors Signature : __________________________________ Emp. Badge # ______ Date: ____________
Mentees Signature: ______________________________________________________Date: ____________
Please return to Glenna Wiles at the BOE no later than June , 2016! Thank you!